Hypertension complicates up to 10% of all pregnancies worldwide. In the United States, preeclampsia affects 5-7% of all pregnancies, approximately 300,000 pregnancies a year. Yet, it disproportionately represents 15% of all maternal-fetal morbidity and mortality. Preeclampsia is known to cause immediate maternal-fetal morbidities such as growth restriction, oligohydramnios, fetal death, maternal seizures, stroke, cerebrovascular hemorrhage, and maternal death (78). Mothers with a history of preeclampsia are at increased risk of future cardiac disease including myocardial infarction and stroke (24, 55, 56). Children born from preeclamptic pregnancies are also at increased risk of stroke (42), epilepsy (98), and metabolic, nutritional and blood disease (97) in later childhood or as an adult. Clearly, preeclampsia has immediate and long term effects on both the fetus and mother. However, its pathogenesis is poorly understood. Consequently, preventative, therapeutic, and curative modalities for preeclampsia are elusive. The only true cure for preeclampsia is the delivery of the fetus and dysfunctional placenta. This delivery is often preterm and contributes to additional morbidity and mortality (78). This fact emphasizes the importance of finding appropriate unifying pathways to be able to treat preeclampsia.
The neurohypophysial hormone, arginine vasopressin (AVP; FIG. 1), is a known regulator of blood pressure and composition in human and animal models. AVP is a major player in blood pressure control in selected populations including African Americans (4), the elderly (21), and in patients with congestive heart (26) or renal failure (3). This hormone appears to specifically be causative in patients with low-renin hypertension (81), which makes up a larger portion of the human essential hypertensive population (27%) than high-renin hypertension (16%) (51). However, whether AVP has a causative role in established preeclampsia has previously been unclear. Establishing such a role for AVP would provide a therapeutic target for the treatment of preeclampsia, which has to date remained elusive.